Our Summary

This study looks at the results of a type of heart surgery known as “valve-sparing root replacement” in children with aortic root aneurysms, a dangerous condition where the root of the aorta (the main artery in the body) becomes enlarged. This surgery is an alternative to replacing the aorta with artificial parts and it allows the child’s own aortic valve to be preserved.

The team looked at 100 cases where this surgery was done between 1997 and 2017. The average age of the patients at the time of surgery was roughly 14 years old. Half of the patients had a genetic disorder called Marfan syndrome, and about 40% had another genetic condition known as Loeys-Dietz syndrome. Both of these conditions can lead to problems with the aorta.

In most cases (80 out of 100), the surgeons used a specific technique involving a Valsalva graft. A few others had slightly different procedures. The mortality rate immediately after surgery was 2%. Some patients needed further surgery later on, often due to the development of pseudoaneurysms, a type of false aneurysm that can be a complication of the original surgery. On average, these additional surgeries happened about 7 years after the original operation.

Overall, this research suggests that valve-sparing root replacement is a safe and effective treatment for children with aortic root aneurysms. The authors note, however, that the risk of late aortic insufficiency (when the aortic valve doesn’t close tightly enough) and pseudoaneurysm formation are potential concerns that need to be monitored.

FAQs

  1. What is “valve-sparing root replacement” surgery?
  2. What are the potential complications of valve-sparing root replacement surgery?
  3. How often do patients need further surgery after a valve-sparing root replacement?

Doctor’s Tip

One important tip that a doctor may tell a patient who has undergone valve replacement surgery is to make sure to follow up regularly with their healthcare provider. This is important to monitor for any complications or issues that may arise, such as aortic insufficiency or pseudoaneurysm formation. It is also important for the patient to continue taking any prescribed medications and to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support the long-term success of the valve replacement surgery.

Suitable For

Patients who are typically recommended valve replacement are those with aortic root aneurysms, particularly children with genetic disorders such as Marfan syndrome or Loeys-Dietz syndrome that can lead to problems with the aorta. The valve-sparing root replacement surgery is a good option for these patients as it allows for preservation of the patient’s own aortic valve, rather than replacing it with artificial parts. This study shows that this surgery is safe and effective in these patients, with a low mortality rate and good long-term outcomes. However, patients may need further surgeries later on to address complications such as pseudoaneurysm formation, so close monitoring is important.

Timeline

Before valve replacement surgery, a patient may experience symptoms such as chest pain, shortness of breath, fatigue, dizziness, and heart palpitations. These symptoms are often caused by aortic valve disease or aortic root aneurysm.

Once a patient undergoes valve replacement surgery, they will typically spend a few days in the hospital for recovery. They may experience some pain and discomfort at the surgical site, as well as fatigue and weakness.

After the surgery, patients will need to follow a strict medication regimen to prevent infection and blood clots. They will also need to attend follow-up appointments with their healthcare provider to monitor their progress and ensure proper healing. Physical therapy may be recommended to help regain strength and mobility.

Over time, most patients will experience a significant improvement in their symptoms and quality of life. However, they will need to continue monitoring their heart health and may require additional surgeries or interventions in the future.

What to Ask Your Doctor

  1. What is valve-sparing root replacement and why is it being recommended for me or my child?

  2. What are the risks and benefits of valve-sparing root replacement compared to other types of aortic root surgery?

  3. How many of these procedures have you performed, and what is your success rate?

  4. What is the expected recovery time and what kind of follow-up care will be needed after the surgery?

  5. What are the potential long-term complications or risks associated with valve-sparing root replacement?

  6. Will I or my child need to take medication or make lifestyle changes after the surgery?

  7. How often will follow-up appointments be needed to monitor for any complications or changes in the condition?

  8. Are there any specific signs or symptoms that should prompt immediate medical attention after the surgery?

  9. What is the likelihood of needing additional surgeries in the future, and what factors may increase that risk?

  10. Are there any specific considerations or precautions that should be taken for individuals with genetic conditions like Marfan syndrome or Loeys-Dietz syndrome undergoing valve-sparing root replacement?

Reference

Authors: Fraser CD 3rd, Liu RH, Zhou X, Patel ND, Lui C, Pierre AS, Jacobs ML, Dietz HC, Habashi J, Hibino N, Cameron DE, Vricella LA. Journal: J Thorac Cardiovasc Surg. 2019 Mar;157(3):1100-1109. doi: 10.1016/j.jtcvs.2018.09.148. Epub 2018 Dec 10. PMID: 30982542